Surgical treatment of anoperineal lesions in Crohn's disease

The treatment of anoperineal crohn disease [APCD] is difficult and still a controversy subject. We reviewed 31 cases, which were 19 men. The middle age was 37 years. The lesions were represented by ulcerations in 14 cases, the fistulas in 28 cases and 2 cases of stenosis of the rectum. An hemorroidary disease was associated at nine patients with 1 case of malignant degeneration. The intestinal location was present at 63% of the cases and mostly in a distal part of the bowel. The biopsy of the APCD had objectives a granuloma in 15 cases and a malpighien carcinoma in one case. The treatment consisted, in addition to the treatment of the intestinal disease, on the hygienic and dietary prescription, metronidazol in 100% of the cases, ciprofloxacin in 7 cases. A treatment by immunosuppressor has been instituted for 2 patients. The surgical treatment done for 14 patients consisted in a drainage of the fistulas through fistulotomy [6 cases], incision of abscess [4 cases], progressive fistulotomy with elastic drainage [2 cases], resection of a fibrous diaphragm [1 case] and abdomino-perineal amputation in one case. The APCD is often invalidating with a real therapeutic problem: how can we treat the infectious process without compromising the sphincterian function

Tuberculosis of the colon. About one case

This illustrating case of primitive colic tuberculosis has permited us to underline its scarcity and its lack of specifity in its clinical and radiological presentation, making the diagnosis difficult especially with cancer. Endoscopy is fundamental because even when caseum or M.B.T. are not found, the endoscopy permits nevertheless to indicate trial treatment showing tuberculoid granuloma. Surgical treatment is necessary essentialy in cases of occlusion or perforation

Diverticular disease of the colon. About 15 cases

The study of 5 cases of colic diverticulosis observed during 12 years and a review of the literature permit the authors to show that this pathology is rare in Morocco, to insist on these different clinical aspects and to show the rarely and especially the gravity of its complications which make colectomy necessary. Finally, the authors notice the importance of the pathogenical and therapeutical part of dietary fibers on matter of colic diverticulosis

tuberculosis of oesophagus. Report of two cases

Tow abservations about the oesophageal tuberculosis have been collected. In the two observation no oesophageal symptomatology has been indicated. The diagnosis of oesophageal tuberculosis has been done on anamnestic, clino, radiologic, enodoscopic and histologic bases. The different anatomic, clinio, radiologic and therapeutic aspects of the oesophageal tuberculosis based on review of literature have been investigated. It is necessary to notice the importance of fibroscopy with biojosies in order to do the diagnosis of the oesophageal tuberculosis

Gastric Polyps. About one case

The authors report on a case of gastric polyposis diffuse and isolated. The affection is rare and not well known. We have tried to emphasize certain aspect of this affection, such as its positive diagnosis which has become easy by the current practice of high fibroscopy. The second problem relates to the evolving risk dominated mainly by the degeneration of adenomatous polyps, but the association of gastric polyposis with stomach cancer is not rare. The gastric polyposis is considered as a precancerous lesion; thus total gastrectomy constitutes the means of therapeutic safety

Primary anorectal melanoma. About one case

The authors report one observation of a primary anorecral melanoma, in a woman of 60 years, diagnosed by biopsy of a pigmented tumour, situated 4 cm above the anal margin. The evolution was fatal by a metastatic diffusion and an abundant rectum haemorrhage within the period of 5 months. Through our case and review of literature we try to bring out the characteristics, particularly the problem of diagnosis and therapeutics of this rare location and a very bad forecast of a primary melanoma